| Author | Title | Comments |
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| Aldmour AF, Salch FE, Erjeh TMA, Premavathi. J Res Dev Nurs Midw 2024, 21(4): 31-35. | The perception of shared governance among nurses at Dar Al Shifa Hospital in Kuwait in 2024. | Background: Shared governance empowers nurses by allowing them to participate in decision-making and be accountable for their professional practices. Involving nurses in decision-making creates a positive workplace culture. Therefore, our objective was to assess the perception of shared governance among nurses working at Dar Al Shifa Hospital in Kuwait. Methods: The study employed a descriptive design and recruited 454 participants utilizing a convenient sampling technique. Data were collected between March 2024 and May 2024 through an online self-administered questionnaire, using the Index of Professional Nursing Governance (IPNG 3.0). The data were analyzed using descriptive statistics, ANOVA, post-hoc analysis, and the independent sample t-test. Results: Findings showed that nurses at Dar Al Shifa Hospital perceived the first level of shared governance in their working environment (Mean±SD: 100.31±25.01). All IPNG subscales indicated shared governance levels except for the personnel and participation subscales. The results revealed no statistically significant differences between registered nurses and nurse managers regarding the level of shared governance (P = 0.231). In addition, there were no statistically significant differences between the nurses' sociodemographic data and the level of shared governance except for the years of experience in Dar Al Shifa Hospital (P = 0.044). Conclusion: The results showed that the nurses perceived the first level of shared governance range in their working environment, indicating that decisions were made primarily by the nursing administration with some staff input. Therefore, implementing a shared governance model, continuous education, and training could improve the nurses' perception of shared governance. |
| Ali KAG, Helal WESH. Int J Novel Res Healthc Nurs. 2018; 5(3):464-475. | Existence of Professional Nursing Governance and Leadership Competency | This research aimed to measure the level of professional shared nursing governance in a high-caliber, high-performance hospital which operates with a partnership with a developed country. A descriptive study design was used to examine the existence of professional shared nursing governance and level of leadership competency by using two reliable scales of data collection, each scale applied to one group of staff nurses working in different nursing units. A total of 70 participants provided a homogeneous sample that was divided into two equal groups. Existence of shared governance was evident in the first group; ian excellent level of leadership competency of head nurses were perceived by the staff nurses in the second group. Conclusion: Nursing shared governance was measured (total score=244/430, cutoff point of shared ≥173) that indicates the presence decisions that made primarily by nursing management/administration with some staff nurse input combined with an excellence level of leadership competency of head nurses (total score=245/260) as perceived by staff nurses at the selected study setting. |
| Allen D, Calkin J, Peterson M. J Nurs Admin. 1988; 18(1):37-43. | Making shared governance work: A conceptual model. | Most of the nursing literature offers little substantive rationale for why Shared Governance works or how to evaluate it. This article presents a model of Shared Governance that is based on more than fifty research articles on participation in decision-making. It gives administrators an overview of why Shared Governance impacts satisfaction and organizational commitment. The model should facilitate both designing a Shared Governance system to fit a particular organization and evaluating that system. |
| Allen-Gilliam J, Kring D, Graham R, Freeman K. J Nurs Admin. 2016; 46(5):257-264. | The impact of shared governance over time in a small community hospital | This study examined the impact of shared governance (SG) on the professional nursing practice environment of a small community hospital over time. Shared governance has been shown to empower nurses in direct patient care to make decisions about their practice and improve job satisfaction. No research has been found that examined the progression of SG over time in a small community hospital. Questionnaires pertaining to the professional practice environment, perception of nursing leadership, nurse empowerment, nurse satisfaction, risk of practice errors, and comfort with evidence-based practice were administered to all nurses employed at a 149-bed community hospital in central North Carolina for five consecutive years. Results showed that nursing leadership and SG explained 90% of the variance in the nursing professional practice environment. This relationship held true for five years. All variables showed continued improvement for four years, until year five when the organization experienced disruptive change. Even during this year, the results did not return to baseline. To improve the professional practice environment of nurses, hospitals should focus on strong nursing leadership and a sound SG infrastructure. Unfortunately this study did not measure SG itself over time. Instead, researchers used the Shared Governance Survey, which the article stated measures nurse empowerment. Also, the cited outcomes were old, even though more current studies of outcomes are available. |
| Anderson E Faye Nurs Admin Q. 2011;35(3):197-203. | A Case for Measuring Governance | Shared governance is promoted as a management innovation designed to improve outcomes of quality patient care, nurse job satisfaction, productivity, and nurse retention. Reported studies have not measured the degree of governance. The Index of Profession Nurse Governance is a valid, reliable tool that can be used to measure the degree of governance, to assess the status and progress of implementation of governance, and in studies relating shared governance to outcomes. An example of the use of the Index of Profession Nurse Governance in one hospital to assess the degree of shared governance over time is described. |
| Ballard N J Nurs Admin 2010;40(10):411-416. | Factors associated with success and breakdown of shared governance | Shared governance, a process for empowering nurses in practice settings, has been widely used for decades. However, despite enthusiasm for the concept, the process is not always successful or falters after successful initiation. To assist nursing leaders trying to implement or maintain SG processes, the author summarizes literature on both human and structural factors that contribute to the success or breakdown of SG practice models. Barriers to implementation and strategies to support implementation, as well as enculturation of SG, are discussed. http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=1071027 |
| Bartmess MP, Myers CR, Thomas SP, et al. AJN. 2024;124(2):20-31. | A Real ‘Voice’ or ‘Lip Service’? Experiences of Staff Nurses Who Have Served on Staffing Committees | Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decision-making. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them. This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate. Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022. Four themes were identified from the data—a “well-valued” committee versus one with “locked away” potential: committee value; “who benefits”: staffing committee beneficiaries; “not just the numbers”: defining adequate staffing; and “constantly pushing”: committee members' persistence. The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees—and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change. |
| Bates M, Pabico C, Dans M, Hume L. Nrsg Mgmt. 2024; 55(4):p 6-10. | 2024 Pathway manual introduction. | The American Nurses Credentialing Center's Pathway to Excellence® (Pathway) Framework serves as an evidence-based blueprint for establishing positive practice environments that foster nursing excellence. This framework is designed to recognize and empower nurses, enhance job satisfaction, improve employee engagement, safeguard clinician well-being, and ultimately improve patient outcomes. Especially with the current healthcare challenges and the global pandemic's emotional toll on nurses, the criticality of creating supportive practice environments and the relevance of the Pathway Framework have been amplified. Organizations that “lived Pathway” and continued to use the framework—practicing shared decision-making, recognizing nurses' contribution, and prioritizing their well-being—thrived and sustained optimum quality of patient care when others struggled. |
| Bernreuter M J Nurs Admin. 1993;23(10):12-14. | The other side of shared governance | Problems and solutions with SG. |
| Bogue RJ, Joseph ML, Sieloff CL J Nurs Manage. 2009;17(1):96-104. | Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness | This study validates an instrument for measuring the effectiveness of nursing practice councils and offers a framework for measuring and understanding shared governance. Empowerment results from the vertical alignment of nursing group power with nursing unit power practices. The field lacks an instrument for measuring nurses? practice of power. Two studies (n1 = 119; n2 = 248) are used to validate the Nursing Practice Council effectiveness scale (NPCes). NPCes is a valid and reliable index of nursing practice council effectiveness. This study suggests specific diagnostic tools to understand two levels for actualized power, one at the group or departmental level and one at the unit level. NPCes and the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) can be used together to improve examination of shared governance. Examining group power as well as unit-level practices may give a more complete view of barriers to nurse empowerment. Changing nursing power and practices in an organization may be made more effective by engaging and monitoring vertical alignment of strategies fostering power competencies among nurse leaders an simultaneously supporting nursing practice councils as a means of exercising nurse authority at the unit level. |
| Bradley CJ. Nurs Leader. 2015;13(5): 73-79.. | Shared governance and rapid response teams beyond clinical practice: The nurse executive advisory cabinet | This article describes how a chief nursing officer implemented a registered nurse participative governance model throughout an Integrated Delivery Network to influence an administrative staff reallocation (float) policy beyond the traditional shared governance model. The model ues a rapid-response approach to provide accelerated problem solving throughout the organization. |
| Brennan D, Wendt L Online J Issues Nurs. 2021;26(2). DOI: 10.3912/OJIN.Vol26No02PPT23 | Increasing quality and patient outcomes with staff engagement and shared governance | The shared governance structure is a nursing practice model which is a hallmark of engaging the front line team into the role of leading practice excellence. The main principles of shared governance include ownership, accountability, empowerment, team building, leadership, innovation, autonomy, and practice equity. Combining these key shared governance principles with formal models can drive sustainable action planning for improvement. This article offers an exemplar describing how we improved shared governance in a community hospital setting. After evaluating findings from a gap analysis, we incorporated guiding frameworks such as the A3 action planning process; the Plan, Do, Check, Act cycle; and Lean methodologies to increase nursing engagement in the shared governance process. Clinical nurses and interdisciplinary teams developed action plans for quality and patient satisfaction improvements. We describe specific improvements to our process, offer examples of our improved outcomes, and discuss essential shared governance factors that were critical to our successes. |
| Brodbeck B J Nurs Care Qual. 1992;6(2):20-31. | Professional practice actualized through an integrated shared governance and quality assurance model | Account and structure of SG at St. Peter's Hospital, Albany, NY. Detailed list of educational programs used. |
| Brody AA, Barnes K, Ruble C, Sakowski J J Nurs Admin. 2012; 42(1):28-33. | Evidence-Based Practice Councils: Potential Path to Staff Nurse Empowerment and Leadership Growth | This study examines the effects of participation in staff nurse?led practice councils on nurse job satisfaction and professional development. Although evidence-based practice (EBP) has become a key component of improving the quality of care, few studies have examined how implementation of staff nurse led councils model affect the involved nurses. A 3-stage evaluation was conducted with nurses, managers, and executives participating in or involved with EBP councils tasked with improving patient outcomes at six community hospitals in a single non-profit hospital system in Northern California. Five themes emerged as outcomes: empowerment, meaningfulness, leadership growth, exposure to quality improvement, and vision. Researchers concluded that staff-led councils have the potential to improve quality of care, job satisfaction, vision and leadership provided that managers and executives are sufficiently prepared to work with and support the councils. |
| Brooks B Online J Issue Nurs. January, 2004;9(1). | Measuring the impact of shared governance | Structure is the easy part of implementing SG. More challenging is changing the behaviors andÿ atttitudes of staff and managers, and measuring the benefits of SG. |
| Brooks F, Mitchel M, Pugh J Nurs Times. 1998:96(46):56-57 | Shared governance as a way of involving staff in decision-making | Ethnographic investigation of shared governance in Kettering General Hospital NHS Trust in the UK looking at commitment to shared governance, communication, and participation. Differences in the perceived value of shared governance were found between those who participated and those who did not participate in councils. |
| Burkman K, Sellers D, Rowder C, Batcheller J Nurs Admin Q. 2012;36(4):353?361. | An Integrated System?s Model of Nursing Shared Governance: A System Chief Nursing Officer?s Synergistic Vehicle for Leading a Complex Health Care System | Seton Nursing reengineered previous models of care and leadership to accommodate rapid growth of its health care system from individual acute care sites to a health care system with consistent quality and standardization of like units across the system. Shared governance promotes collaboration with shared decision making and accountability; however, the role and methods of a system chief nursing officer to connect shared governance across a new system has not been previously described. A system chief nursing officer can significantly influence and guide the nursing strategic direction at all the health care system-related facilities by utilizing a single, systemwide nursing shared governance structure. Using this structure provides a venue to maximize the influence of a transformational leader and creates efficiencies in workforce development, resource management, best practice identification, and spread of initiatives and improvements to adapt to an ever-changing health care landscape. This is the story of one such system chief nursing officer. |
| Chamberlain B, Bersick E, Cole D, et al. Nrsg Manag. 2013;44(10):16-18. | Practice models: A concept analysis | This long-overdue concept analysis does a great job of sorting out the differences between professional practice models, care models, care delivery models /system, and shared governance. |
| Constantinides GH, Tscharner D, Kalpowsky D, Baker-Priebe R J Nurs Manag. 1994; 25 (12):32O-P. | Increasing autonomy: A self-directed MICU | An Account of the implementation of unit-based SG through a self-directed work team (without a manager) on a newly created medical intensive care unit at Greater Baltimore Medical Center, an organization with a hospital-wide SG program. |
| Clavelle JT, Porter-O’Grady T, Drenkard K. JONA. 2013; 43(11)11:566–573. | Structural empowerment and the nursing practice environment in Magnet® organizations | This landmark study describes the characteristics of shared governance and its relationship with nursing practice environments in Magnet® organizations. Structural empowerment is a core Magnet model component illustrated through shared governance. Not much f literature exists describing it and its relationship to the nursing practice environment in Magnet organizations. E-mail surveys of Magnet chief nursing officers and leaders of their organization’s nursing practice council were conducted using the Index of Professional Nursing Governance (IPNG) and the nursing Work Index–Revised (NWI-R). In Magnet organizations, the primary governance distribution is shared governance, with most subscales in the IPNG within the shared governance range. Total and subscale scores on the NWI-R ranged from 1.35 to 1.48, with significant, positive correlation between total IPNG score and total NWI-R score (r = 0.416, P < .001), as well as the NWI-R and IPNG subscales. This study provides new evidence that demonstrates the positive relationship between shared governance and the nursing practice environment in Magnet organizations. |
| Crawford CL, Omery A, Spicer J Nurs Admin Q. 2017:41(4):297-309. | An integrative review of 21st century roles, characteristics, and competencies of chief nurse executives. A blueprint for the next generation. | The authors lists that CNEs have a responsibility to establish a nursing governance structure and that a major competency is in shared decision making. Executive nursing practice is experiencing “head-snapping change.” Health care has transitioned from the managed care era to the disruptive innovation era. As chief nurse executives (CNEs) navigate evolving care delivery models, they must consider retooling their roles and responsibilities related to emergent models. This integrative review’s purpose was to examine evidence for the roles, responsibilities, characteristics, and competencies of CNEs and system CNEs to better guide future generations of nurse executives. Ganong and Cooper’s integrative review methodology was chosen to guide the evidence synthesis. Seventeen articles were identified that pertained to the clinical inquiry. The evidence is inconsistent for specific CNE roles, responsibilities, characteris-tics, and competencies due to many areas of overlap and an absence of definitions. The evidence does describe who CNEs are, what they do, and how they articulate executive practice. Embed- ding evidence regarding emerging roles, responsibilities, characteristics, and competencies into the personal journeys of nurse executives helps articulate shifting paradigms and the CNE’s role in transforming health care. Review results have the potential to create a blueprint for the recruitment, development, and retention of the next generation of nurse executives. New knowledge for the ever-changing worlds of CNEs is needed by robust research studies and other evidence. |
| Dearmon VA, Riley BH, Mestas LG, Buckner EB. Nurs Adm Q. 2015;39(1):69-77. | Bridge to shared governance: developing leadership of frontline nurses. | Transforming health care systems to improve quality is the responsibility of nurse executives and frontline nurses alike, yet frontline nurses are often ill-prepared to share leadership and accountability needed for transformation. The aim of this qualitative study was to describe the process used to build leadership capacity of frontline nurses engaged in resolving operational failures interrupting nursing care. The leadership development process served to bridge staff transition to shared governance. This institutional review board-approved qualitative research was designed to identify the effects of mentoring by the chief nursing officer and faculty partners on leadership development of frontline nurses working to find solutions to operational failures. Twelve nurses from 4 medical surgical units participated in a Frontline Innovations' nurse-led interdisciplinary group, which met over 18 months. Transcriptions of audiotaped meetings were analyzed for emerging process and outcome themes. The transcripts revealed a robust leadership development journey of frontline nurses engaged in process improvement. Themes that emerged from the mentoring process included engagement, collaboration, empowerment, confidence, and lifelong learning. The mentoring process provided frontline nurses the leadership foundation necessary to initiate shared governance. |
| DeBaca V, Jones K, Tornabeni J J Nurs Admin. 1993; 23 (7/8):50-57. | A cost-benefit analysis of shared governance | One of the best reports about the cost of implementing SG: direct and unmeasured costs and savings over 5 years at Mercy Health Care, San Diego, CA. |
| Dechairo-Marino AE, Collin ME, Mendelson SG, Highfield MEF, Hess, RG. J Nurs Admin. 2018; 48(9): 445-451. doi: 10.1097/NNA.00000000000 | Enhancing and advancing shared governance through a targeted decision-making redesign | The study aim was to determine if a targeted redesign of shared decision making improved shared governance (SG). Nursing SG is collaborative decision making between nurses at every level; it improves quality of care, empowers nurses, and enhances nurse satisfaction. Using a quasi-experimental, pretest/posttest design, researchers electronically distributed the Index of Professional Nursing Governance (IPNG) to an inclusive, convenience sample of RNs in a Magnet®-designated 377-bed community medical center. Preintervention scores were used to tailor a redesign of shared decision making, and postintervention data were collected within 1 year to measure outcomes. IPNG overall score and 5 of 6 subscale scores significantly increased after the redesign. Changes to an SG structure can take 2 to 5 years to be realized. Our findings corroborate that the IPNG is a valuable tool in promoting setting-specific SG. |
| Densmore J, Gbadebo C, Johnson C, Whitehead D. Nurs Leader. 2015;13(6):35-6. | Shared leadership: Leaders and shared governance—Working together to improve staffing at WellStar Kennestone Regional Medical Center | Healthcare organizations in the United States and around the world are challenged with securing and retaining nurses at the bedside. WellStar Kennestone Regional Medical Center is confronting the challenge by developing a multipronged approach. Recruiting and retaining talented nurses with the skill sets to meet the clinical needs of a complex patient population in order to continue providing quality care is a top priority. The chief nursing officer and nursing leadership understand that confronting this persistent matter will require a multifaceted tactic. This article highlights leadership working with frontline team members in a Shared Governance model to set in motion processes that ensure appropriate staffing is available to deliver world class healthcare |
| Di Fiore T, Zito A, Berardinelli A, Bena J, Morrison S, Keck D, Kennedy K, Stibich A, Albert N. J Nurs Admin. 2018; 48 (11):561-566. | Staff perceptions of decision-making in a shared governance culture. | This study evaluated differences in the shared decision-making perceptions of clinical nurses between initial implementation of a shared governance model and perceptions 3 years later after the model has matured. Shared decision-making empowers nurses to have a voice in their practice and supports engagement and retention. A prospective, 2-group comparative design was conducted using the Index of Professional Nursing Governance, a validated, reliable tool. After comparing data univariately, a multivariable linear regression model was used to evaluate the impact of nurse characteristics on shared decision-making responses. The mean overall shared decision-making score (P = .23) and domain scores (P values between .055 and .63) did not increase in 2015 compared with 2012. After adjusting for differences in nurse characteristics between groups, overall score (P = .017) and 3 of 6 domain scores improved: professional control of work, structures for decisions and access to information (all P values between .005 and .031). As shared governance became established, shared decision-making scores increased. |
| Doherty C, Hope W J Nurs Manag. 2000;8(2):77-81. | Shared governance - nurses making a difference | UK. Leicester Gen Hos. SG councils integrated into existing mgmt structure to increase nurses' involvement in decision-making. |
| Dunbar B, Park B, Berger-Wesley M, Cameron T. J Nurs Admin. 2007;37:177-183. | Shared governance. making the transition in practice and perception. | Detailed report of the implementation of both nursing division-wide and unit-based councilar shared governance model over two years at James A Haly Veterans' Administration Hospital, Tampa, FL. |
| Dunton N, Montalvo I, eds. Am Nurse Today. 2009;4(7):34-36. | In Sustained Improvement in Nursing Quality: Hospital Performance on NDNQI Indicators, 2007-2008. Issues Up Close. Quality improvement using NDNQI. | Excerpt from book reports an increase in RN satisfaction and favorable RN-MD interactions in Westchester Medical Center in rural northwestern Virginia from 2005, 2006 and 2007 after the implementation of shared governance, including unit-based and house-wide councils. No measure of change in governance except the implementation of councils, changes in leadership, and a flattened hierarchy. |
| Dus JE. Nurs Leader. 2019;4(2):121-124 | Creating a new nursing identity during a merger: Respecting the past and designing the future | The mergers of two similar healthcare systems presented a unique opportunity for nursing integration. By drawing on the strengths and respecting the work of the legacy organizations, the new system laid the foundation to create a new professional nursing identity. This article describes a complex, sophisticated system-side shared governance model as part of the merger of 27 hospitals with more than 500 sites of care. |
| Edwards D, Brzozowski S, Rees S, Reisman M, Misna MJ, Rankin R. Am Nurse. 2021;16(10):66-8, 70. | Advancing shared Governance during a pandemic | https://www.myamericannurse.com/advancing-shared-governance-during-a-pandemic/ |
| Edwards GB, Farrough M, Gardner M, Harrison D, Sherman M, Simpson S. J Nurs Manag. 1994;25(4):74-77. J Nurs Manag. 1994;25(4):74-77. | Unit-based shared governance can work! | Account of how a unit-based SG model was implemented over three years in a 10-bed medical intensive care unit at St Joseph Mercy Hospital, Ann Arbor, MI. |
| Ellenbecker CH, Samia L, Cushman MJ, Porell FW Home Health Care Serv Quarter. 2007;26:43-58. | Employer retention strategies and their effect on nurses' job satisfaction and intent to stay | Data from 24,459 nurses from 123 New England home care agencies showed that the only retention intervention that had a statistically significant effect on nurses' intent to stay was shared governance through its indirect effect on job satisfaction. No retention strategy directly affected nurses' intent to stay. |
| Erickson JI, Hamilton, GA, Jones DE, Ditomassi M J Nurs Admin. 2003;33(2):96-104. | The value of collaborative governance/staff empowerment | Longitudinal comparison of empowerment and power scores for members and nonmembers of collaborative governance program at Massachusetts General Hospital. |
| Ethridge P Health Progress. 1987;May:44-49. | Nurse accountability program improves satisfaction, turnover | Classic longitudinal study links reorganization of professional practice environment to higher job satisfaction and lower job stress at St Mary's Hospital, Tucson, AZ |
| Fisher CA, Hubbard MLNurs Manag. 2015;46(7):16-18. | Extending evidence through shared governance | Using shared governance structures to disseminate evidence-based practices through the hospital |
| Flynn MK Doctoral dissertation. University of San Diego, 1997 | Correlates of staff nurse work satisfaction in hospitals with shared governance | Lack of staff nurse participation in hospital decision-making has been cited as a major reason for the dissatisfaction in nursing. Shared governance has been proposed as an organizational model that provides staff nurses with both the structure and the mechanism for having increased decision-making authority. The purpose of this study was to investigate the relationship of organizational culture, perceived importance of involvement and actual involvement in decision-making, the discrepancy between importance and involvement, staff nurse years of involvement in shared governance, control over nursing practice, and work satisfaction among staff nurses working in hospitals with shared governance. A descriptive, correlational design was used to investigate 188 full-time RN staff nurses from three hospitals with shared governance. Organizational culture was eliminated from analysis because of the large amount of missing data. Three multiple regression models were tested. In the final prediction model, control over nursing practice was the strongest predictor of work satisfaction, accounting for 40% of the explained variance. The next most significant predictors were involvement in decision-making, years in shared governance, and years in nursing, for a total of 43% of the variance. Since the variables in the model only explained 43% of the variance, other factors need to be identified to further predict work satisfaction. Based on the findings in this study, staff nurse participation in shared governance is a vehicle for control over nursing practice and work satisfaction. |
| Franklin B, Murphy M, Cook P. Nurs Manag. 2014;45(11):44-49. | Shared governance in an Army clinic: Implementing unit practice councils | One army facility's implementation of shared governance through the creation of a unit practice council. |
| French-Bravo M, Crow G. The Online Journal of Issues in Nursing. 2015;20:2. | Shared governance: The role of buy-in in bringing about change | The term buy-in can be found in almost any article considering individuals’ participation in an initiative. At the time of this writing, a Google search of buy-in resulted in 10.5 billion hits. The term buy-in seems intuitive, yet many healthcare organizations struggle to implement and sustain initiatives that depend on nursing buy-in and involvement. The purpose of this article is to identify prerequisites to buy-in and factors that facilitate buy-in which, when cultivated, may positively influence nurse engagement. In this article, the authors discuss the concept of buy-in, identify prerequisites for buy-in, consider factors to enhance buy-in, and present scenarios of what happens when buy-in happens, when it almost happens, and when it fails. They also consider future directions to facilitate buy-in by nursing staff members. |
| Frith K, Montgomery M Nurs Admin Q. 2006;30(3):273-284 | Perceptions, knowledge, and commitment of clinical staff to shared governance | Large SE US medical center surveys one year apart, pre- and postimplementation showed decrease in perception and knowledge, but an increase in commitment to SG. |
| Wilson RC, Galuska L. Nurs Leader. 2020; 18(5):467-470. | Professional governance implementation: Successes, failures, and lessons learned. | The implementation story of system-wide shared governance is another narrative from an apparently parallel universe that treats professional governance as if it is new terminology, even though it has been around since 1992. The authors apparently missed more than 60 articles about professional governance https://sharedgovernance.org/?page_id=58 in their 17-citation reference list. This detracts from the credibility of this article. |
| Gavin M, Ash D, Wakefield S, Wroe C J Nurs Manag. 1999;7(4):193-200. | Shared governance: time to consider the cons as well as the pros | Methodologic flaws and bias for SG suggests research should be treated with caution. |
| George V Doctoral dissertation. Marquette University, Milwaukee, Wisconsin | An organizational case study of shared leadership development in nursing | This case study documented a process of organization change over eight years in one nursing collective's attempt to implement a professional practice model. The qualitative analysis demonstrated the key elements for implementation of shared governance and the establishment of a peer review system. These elements were training for shared leadership, goal setting with feedback, mentoring, and role modeling. The shared leadership training program resulted in significant (p < 000) changes in leadership behaviors and practice autonomy scores as measured by Leadership Practices Inventory and Schutzenhafer Nursing Activity scale, respectively. When managers and staff leaders use shared leadership in a bureaucratic healthcare organization, they strengthen the staff nurse's autonomy at point of service. Implications and recommendations directed to nurse executives, educators, researchers, and clinical staff are included. |
| George V, Burke L, Rodgers B, et al. Nurs Admin Q. 2002;26(3):44-59. | Developing staff nurse shared leadership behavior in professional nursing practice | A conceptual model of shared leadership development was applied to a research program at Aurora Health Care - Metro Region in Eastern Wisconsin. Findings demonstrated that the implmentation of a shared leadership concepts program increased staff use of leadership behaviors, professional nursing practice autonomy, and improved patients outcomes. |
| George VM, Burke LJ, Rodgers BL J Nurs Admin. 1997;27(5):53-61. | Research-based planning for change: Assessing nurses attitudes toward governance and professional practice autonomy after hospital acquisition | Medical center surveyed nurses in an acquired hospital for attitudes about the acquiring hospital and the merger, and toward governance and autonomy to guide transition strategies. |
| Giamba B, Kneflin N, Morath H, Lee J, Morris E. Nurs Leader. 2018; 16(1):48-53. | Meaningful participation and effective communication in shared governance. | This modified Delphi study was undertaken to determine which behaviors constitute meaningful participation in shared governance and to generate ideas for improving dissemination of information among SG councils and the point of care. Results were incorporated into a redesigned SG structure including dedicated time, manager support, and a standardized process for information dissemination. |
| Gloeckner MB, Robinson CB J Nurs Staff Development. 2010;26(6):267-270 | A nursing journal club thrives through shared governance | This article documents the creation and introduction of a journal club for disseminating nursing research to staff through a shared governance council at a Midwestern hospital. |
| Graham-Dickerson P, Houser J, Thomas E, Casper C, ErkenBrack L, Wenzel M, Siegrist M. J Nursing Admin. 2013;43(5):286-292. | The value of staff nurse involvement in decision making | This study explored the perceptions of hospital-based staff nurses regarding their involvement in decision making and looked at the ways nurses would like to be involved in decision making. How nurses want to be involved and the extent to which hospital-based staff nurses are involved in formal and informal structures for decision making remain unknown. Stratified cluster random sampling was used to identify hospitals to participate in the study. Staff nurses and chief nursing officers (CNOs) from 10 hospitals in Colorado were invited to participate in this qualitative descriptive study informed by grounded theory. Focus groups with staff nurses and individual interviews with CNOs were also conducted. Safe quality patient care was threaded throughout discussions among the staff nurses and CNOs. Staff nurses viewed involvement in decision making through the lens of an egalitarian process, whereas administration viewed involvement as soliciting input but making decisions unilaterally. |
| Hafeman P. Nurs Leader. 2015;13(5): 69–72. | What does it mean to Be part of a system? The role of the chief nurse executive and shared governance | This article describes how the role of the nurse leader and the shared governance structure has evolved into a divisional structure and how this structure functions in the Hospital Health System, Eastern Wisconsin, in Green Bay, Wisconsin. |
| Hall DS Doctoral dissertation. The Graduate School, University of Kentucky, Lexington, Kentucky, 2004. | Factors charaterizing supportive nursing care units for registered nurses | This two-phase comparative study explored the relationships between nursing unit environment (shared governance, traditional governance, specialized inpatient care unit) with measures of registered nurse occupational stress and occupation-related outcomes in a hospital with a reputation for excellent nursing care. Survey data from 69 staff nurses in one of the three different patient care areas were analyzed using parametric and nonparametric univariate, bivariate and multivariate analyses. A sample of nurses working in each of the units also were interviewed about common work stressors encountered, coping mechanisms used to deal with work stress, decision-making, and sources of work support. No significant differences were found among the three types of nursing unit governance structure on occupational stress, methods of coping with occupational stress, job control, and self-efficacy. Significant differences were found related to amount of supervisor support, coworker support, unit efficacy, turnover, absenteeism, and job satisfaction. Nurses working in the shared governance and specialty units had more job satisfaction, perceived coworker support, and unit efficacy than RNs working in the traditional governance unit. Specialty unit structure was associated with less turnover, and shared governance and specialty unit structure were associated with less absenteeism related to illness. Supervisor support was associated with more positive occupation-related outcomes than unit governance structure. Gender and education were associated with perception of work stress. |
| Hartley LA. JONA. 2014;44(6):315-317. | Implementing shared governance in a patient care support industry. | Implementing technology in the clinical setting is not a project, but rather a journey in transforming care delivery. As nursing leaders in healthcare and patient care support organizations embrace technology to drive reforms in quality and efficiency, growing opportunities exist to share experiences between these industries. This department submission describes the journey to nursing shared governance from the perspective of an information technology–based company (Cerner) realizing the goal of supporting patient care. |
| Hashish AA, Fargally SM. J Nurs Ed and Pract. 2018;8(3):37-47. | Assessment of professional nursing governance and hospital Magnet components at Alexandria Medical Research Institute, Egypt | Background and objective: In the context of a rapidly evolving health care system, health care institutions strive to set a path towards an excellent professional practice environment. Since improving clinical nurse work environments is a major issue faced by nurse executives and administrators, they become challenged to establish nursing governance models, and leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. The main aim of this study was to assess the current status of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt. Methods: A descriptive research design was conducted at Alexandria Medical Research Institute hospital, using a convenience sample (N = 220) that composed of two groups including; all hospital medical administrators (n = 10) and hospital nursing workforce (n = 210). Index of Professional Nursing Governance Questionnaire (IPNGQ) and Magnet Hospital Forces Interview were proved valid and reliable to measure study variables. Results: The overall mean score of professional nursing governance was (187.59 ± 63.74) reflected that staff nurses practice the first level of nursing shared governance (primarily nursing management who take the decision with some staff input). In addition, both medical administrators and nursing staff identified the hospital has a good structure, nursing leadership practices that support shared governance and magnet recognition. Structural equation model and correlation analysis revealed a positive association between overall professional nursing governance and hospital magnet components (p < .05). Conclusions and recommendations: The study emphasized the hospital administrators’ important role for providing supportive organizational structures and leadership practices for increasing participation of nursing staff in work design, problem-solving, conflict resolution, committees and organizational decision-making as “key ingredients to a successful organization” in turn, lead to a healthy and magnet-like work environment. Training programs for nurses’ professional development are recommended which enhance and increases their autonomy and empowerment. |
| Havens D, Vasey J J Nurs Admin. 2003;33(6):331-336. | Measuring staff nurse decisional involvement: The decisional involvement scale | Description of the development, content, and scoring of the Decisional Involvement Scale, a multipurpose measure that can be used as a diagnostic tool, an organizational strategy, and an evaluative instrument. |
| Hendrian K, Tipton E Nurs Manag. 2020;51(12):10-12. | Decreasing hospital falls with injury: shared governance and multidisciplinary empowerment | T-test looks decreased rate of falls with injuries at pre- and post-implementation of shared governance at Blessings Hospital, Quincy, IL. However, no measure of shared governance included. |
| Hess R Nurs Res. 1998;47(1):35-42. | Measuring shared governance | Reports the development, reliability, and validity of the Index of Professional Nursing Governance. |
| Hess R Nurs Admin Q. 2011;35(3):235-241. | Slicing and Dicing Shared Governance: In and Around the Numbers | Hospitals seeking Magnet status must demonstrate empowering structures and processes that involve nurses in governance and decision-making about their practice. Shared governance ? an organizational innovation that legitimizes healthcare professionals? decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers ? can achieve this. Evidence connecting shared governance with clinical, professional, and organizational outcomes has been sparse. Research using the Index of Professional Nursing Governance (IPNG) is changing that. Innovative uses of the IPNG is strengthening new shared governance programs, rejuvenating old ones, and finally connecting innovative models to favorable outcomes. |
| Hess R, DesRoches C, Donelan K, Norman L, Buerhaus P J Nurs Admin. 2011;41(7/8):315-323. | Perceptions of nurses in Magnet hospitals, non-Magnet Hospitals, and hospitals pursuing Magnet status | The objective of the study was to compare perceptions of RNs employed in Magnet?, in-process (ie, hospitals seeking Magnet recognition), and non-Magnet hospitals using data from the 2010 National Survey of Registered Nurses (NSRN). The NSRN is administered biennially and measures nurses? perceptions about their profession, workplace environment, and professional relationships. A self-administered mail survey to a national sample of 1,500 RNs was used. Bivariate statistical techniques were used to analyze responses from 518 nurses who indicated their employer?s Magnet status and to examine associations between Magnet status and the nurses? perceptions of career satisfaction, the nursing shortage, work environment, opportunities to influence the workplace, and professional relationships. Nurses employed in all 3 groups (Magnet, in-process, and non-Magnet hospitals) were uniformly satisfied with being a nurse, although significantly more Magnet and in-process nurses would recommend nursing as a career than would non-Magnet RNs. Views of workplace safety were similar across groups, with no significant differences in violence, verbal abuse, discrimination, or harassment; however, Magnet nurses reported significantly more musculoskeletal injuries. Magnet and in-process nurses rated opportunities to influence decisions about workplace organization and participate in shared governance and employer-paid continuing education, and relationships with advanced practice nurses and nursing faculty higher than did non-Magnet nurses; relationships with new nurses and physicians were not different across groups. The Magnet program continues to have a positive influence on nurses, their decision making, and their professional relationships. The paucity of other differences suggests that Magnet, in- process, and non-Magnet organizations are increasingly guided by a shared set of principles that define a positive professional environment derived not only by the Magnet program, but also by other professional organizations and forces. This survey marks the first time the occurrence of shared governance in American hospitals was measured on a national scale. |
| Hess R, Tebben A. Imprint. 2018; 65(3):38-41. | Participating in shared governance, from student to nurse | An overview of shared governance in the National Student Nurses Association and the student's experience when transitioning to the role of employee and professional participating in hospital shared governance. |
| Howell JN, Frederick J, Olinger B, Leftridge D, Bell T, Hess R, Clipp EC. J Nurs Admin. 2001;31(4):187-195. J Nurs Admin. 2001;31(4):187-195. | Can nurses govern in a government agency? | VA medical center surveyed nurses' perceptions of governance to determine the degree to which a shared governance model had been implemented. This is the first article that explores how the certain restrictions and characteristics of an organization or organizational system, like the VA, can determine how SG looks after it is implemented. |
| Huntington K, Goodyear C. Nurs Mgmt. 2018;49(9):14-19. | Integrating lean with shared governance | Full description of lean methodology, continuous improvement, and shared governance. |
| Jenkins J Nurs Econ. 1988;6:302-311. | A nursing governance and practice model: what are the costs? | 5-yr cost comparison after SG implementation at Southern tertiary MC: 3%increase in meeting time, 14% reduction in meeting hrs per budgeted FTE. |
| Jan E, Henseler K. Nurs Manag. 2025: 56 (6 July):16-62. | Enhancing team cohesion in postpandemic healthcare: professional governance and relational leadership in a merged perianesthesia care unit. | The relational leadership style is crucial for success in the ever-evolving landscape of healthcare (particularly nursing), as it builds inclusive and synergistic relationships across various healthcare disciplines. This style emphasizes nurturing connections and promoting a culture of empathy and collaboration, which are foundational for effective clinical practice and enhanced organizational health.1,2 Relational leadership's subset approach, transformational leadership, is recognized for its potential to inspire and motivate, as well as for providing employees with a compelling vision that promotes idealized influence and intellectual stimulation.3,4 This leadership paradigm is vital for cultivating environments that empower nurses to own their practice and decision-making processes, which in turn significantly enhances patient care, nurse satisfaction, and workflow efficiency.2,3,5 Professional governance, a pivotal framework within this dynamic, plays a crucial role in creating opportunities for shared decision-making and enabling nurses to substantively influence patient outcomes. Professional governance also cultivates a culture of empowerment and accountability, which is essential for professional growth and improved care standards.5-7 Together, relational and transformational leadership models and professional governance heighten staff engagement and satisfaction and bolster patient-care quality, making them indispensable in contemporary nursing practice. Both transformational and relational leadership approaches significantly increase engagement among nursing teams, underlining the importance of a supportive and positive work environment in which staff feel valued and engaged.2,3,5,8,9 PROJECT SETTING AND BACKGROUND A large urban academic hospital consolidated its preoperative, ambulatory surgery, and postanesthesia care units into a single perianesthesia care unit (PACU) to enhance patient throughput and operational efficiency. Because each unit had decades of distinct history and preestablished nursing cultures, the merger introduced significant complexities into an already challenging environment. To support the newly formed PACU, leaders focused on teamwork and staff engagement, as well as equipping staff with the knowledge and support necessary to adapt to new workflows and providing cross-training to manage the diverse care areas effectively. The nursing professional development team, project management team, and human resources worked together in intense collaboration to facilitate this transition; however, despite their combined efforts, it initially proved difficult to foster teamwork and secure staff engagement. Delivering effective perioperative services in a complex, urban academic medical center requires continuous collaboration among multidisciplinary teams and a deep understanding of interdepartmental dynamics. This scenario represents a complex hospital system where professional governance is a crucial framework to support staff engagement and effective teamwork.3,10 Therefore, in the face of these challenging dynamics and the broader difficulties posed by the pandemic, leadership decided to prioritize building strong connections within the PACU team and across different disciplines to improve teamwork and engagement. Acknowledging the need for additional support, nursing leadership also committed to strengthening professional governance through a multilayered mentorship approach. METHODOLOGY The authors used the Plan-Do-Study-Act cycle to conduct this quality improvement project and improve staff unity and retention. The project focused on changing team culture by utilizing relational leadership to help strengthen professional governance structures, establish a multilayered mentorship program, and build staff engagement. Sample and setting This project took place in a large (81-bay) academic medical center PACU that serves the preoperative and postoperative process for the ambulatory surgery and surgery admit populations. The unit includes 150 perianesthesia care staff (clinical nurses I, II, and III; patient care associates; unit assistants; patient navigators; transporters; and unit clinical instructors). The unit's clinical nurses II and III also serve as charge nurses and preceptors. Measures Staff engagement was assessed using data from annual Gallup Staff Experience Surveys conducted in 2021, 2022, 2023, and 2024. To ensure a comprehensive evaluation, all 150 staff members were invited to participate in the survey. Staff were assured that survey data would be anonymous and were therefore encouraged to provide honest, uninhibited feedback. The Gallup Staff Experience Survey measures various facets of staff experience on a Likert-type scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The Gallup survey agency calculated the engagement mean score by averaging the scores of the survey's engagement-related questions and offered detailed analysis (such as percentile rank in industry) using the agency's proprietary calculations.11 Finally, the authors utilized full- and part-time nurse turnover rates for 2021 through 2024 to track changes and trends over time. INTERVENTIONS Plan A strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted, and several needs were identified: increased leadership support, restructuring of the mentorship program, stronger professional governance structures, and improved trust and connection among staff. The PACU leadership team reorganized the unit's leadership and professional governance structures, which expanded coverage times and fostered greater unity among coverage areas. Clinical nurse managers' (CNMs') scope transitioned to oversee both the PACU and Pre-Op care areas, reinforcing the concept of a single, integrated perianesthesia service. CNM coverage hours were staggered from early morning to late evenings to provide consistent leadership presence across all staff schedules. The unit-based clinical instructor role expanded to serve as the clinical content expert for all care areas and introduced flexible hours, again ensuring support to all shifts. Additionally, collaboration with OR leadership was strengthened, allowing for leadership visibility and support for shared responsibilities, such as first case on-time starts (FCOTS), during critical hours. These measures created more opportunities for leadership-staff connections and bolstered on-site support during the unit's busiest periods. To enhance the team's unity and increase staff ownership of the consolidated unit, the individual care area professional governance structures were combined into one unit council and multiple committees, ensuring each care area had representation, to address the needs of the team. Relational leadership laid the groundwork for building trust, which enabled leadership to develop a multilayered mentorship program. This program was structured so that experienced nurse leaders would mentor less experienced nurse leaders, clinical nurse managers would mentor and sponsor unit council and committee chairs, and unit council and committee chairs would mentor frontline nurses. This structure helped cultivate a “one team” mentality among staff while fostering professional growth, strengthening professional governance structures, and building team reciprocity. Do The frontline leadership team engaged in group biweekly mentorship sessions with senior leaders across disciplines. The sessions focused on building leadership skills, and topics included mentoring, conflict resolution methods, appreciative inquiry, and quality and process improvement case studies. The leadership team also had weekly 1:1 meetings to review progress, discuss barriers, and receive assignments focused on leadership growth. Each nurse leader was tasked with mentoring and sponsoring a committee. Leaders conducted weekly or biweekly mentorship sessions with council/committee chairs to review agendas, minutes, data, and progress of projects; escalate barriers; and coach committee members between committee meetings. During these sessions, the PACU nursing leadership and unit council/committee chairs discussed recruiting staff to committees based on their individual interests, shared unit vision, and goals. Introducing multilayered mentorship helped support staff professional development and encouraged active participation in decision-making processes.3,4 Using the relational leadership approach, leaders leveraged communication structures such as huddles, emails, monthly team meetings, and monthly unit councils to build trust and foster connection, as well as receive continuous feedback from the frontline team. These communications allowed for consistent and open feedback on interventions and gave the committees the opportunity to pivot interventions as needed. Professional governance was further expanded during this time with the addition of five unit council subcommittees (the Magnet Committee, PACU Press, the Technology Committee, the Safety Committee, and the Beacon Award Committee) in addition to four existing subcommittees (Education; Quality; Recruitment, Retention, Recognition, and Respect or R4; and Patient Experience) to align the council with the organization's broader strategies and staff interests. Committees structured daily huddles for reporting and included their projects within the unit's professional governance framework. Study Adopting a consistent, multimodal communication structure allowed the unit leadership team to receive real-time feedback on the project interventions. Feedback on the interventions was routinely solicited during the weekly mentorship meetings, via email, and in conversations about committee activities, committee attendance rates, and project progress status. Relational leadership and visibility intervention. Adopting a relational leadership approach was key in significantly improving trust and openness within the team.3 This shift led to better communication, a clearer understanding of mutual expectations, and enhanced team development and performance. The increased presence and visibility of leaders on the unit facilitated more regular interactions, making leaders appear more approachable and in tune with the daily challenges staff faced, which promoted autonomy and a shared vision.12,13 This approach not only met the team's basic needs but also provided essential resources, thus enhancing staff engagement by helping staff find greater meaning in their work and reducing job stress.12,13 Multilayered mentorship and professional governance structures. The PACU's professional governance structure was the culmination of feedback from frontline nurses and consistent multilayered mentorship, alignment with organizational strategies, and a professional governance framework structured to support the realization of the team's projects and ideas. Working together, the team created a goal to earn the American Association of Critical-Care Nurses (AACN) Beacon Award for Excellence. The expanded professional governance structure with nine subcommittees allowed frontline team members to take initiative by championing their ideas and implementing innovative solutions. Each committee received mentorship from leadership, which helped to align the committee's projects with the organization's initiatives, vision, and mission (see Figure 1). This approach fosters a collaborative environment where all voices are valued and empowered to drive positive change. F1-4 FIGURE 1:: Multilayered mentorship Act Based on team feedback, unit leadership adjusted many different facets of the intervention to meet the team's needs, including mentorship discussion topics and structure, team projects, committee meeting format, and the distribution of resources. Leadership support and mentoring sessions were also adjusted following a leadership debrief. Leaders then reflected on this feedback for another PDSA cycle. RESULTS After 3 years of dedicated intervention, the unit observed significant improvements in several key performance indicators. The unit's Gallup Employee Experience Survey scores showed a notable increase of 39.7% (equivalent to more than a full data point of 1.16), along with an 80% staff survey participation rate—double that of 2021. The nursing turnover rate from 2021 to 2024 decreased by 6 data points, which is a 53.1% reduction in turnover rate. These results underscore the effectiveness of the targeted strategies implemented (see Table 1). TABLE 1: - PACU quality metric improvement Metric Percent change/improvement (2021 vs. 2024) Gallup survey engagement mean Improved by 39.7% Turnover rate Reduced by 53.1% PACU hold hours Reduced by 95% FCOTS Improved by 104.5% During the intervention period, the team attained its goal when the unit received the AACN Beacon Award for outstanding performance in nursing excellence. This impressive achievement, a first for a PACU in the region, serves as a testament to the team's positive changes and unwavering commitment to excellence. Additionally, during this period, the unit experienced a 50% increase in clinical ladder participants and an increase in patient satisfaction, consistently rated above four stars on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) assessment. The unit also made notable improvements in various quality and efficiency metrics, including a 95% reduction in PACU hold hours (an efficiency metric related to patient flow from the OR to the PACU) and a 104.5% improvement in FCOTS from 2021 to 2024. Furthermore, there was a decrease in both patient safety incidents and employee safety events. These results collectively demonstrate the unit's enhanced operational efficiency and workplace environment, significantly contributing to staff well-being and patient-care standards. LESSONS LEARNED During this quality improvement project, the leadership team learned that the right leadership structure can offer a strong foundation for cultural changes—relational leadership promotes meaningful mentor/mentee relationships, a multilayered mentorship approach can strengthen professional governance, and transparent and consistent communication and feedback structures can aid in transforming unit culture (see Figure 2). F2-4 FIGURE 2:: The power of multilayered mentorship One major challenge that arose was ensuring leaders could balance leadership tasks to make time for mentorship and sponsorship on top of other administrative tasks, projects, and responsibilities. The support of the entire leadership team in redistributing tasks and workload was vital to the success of the interventions; thus, it's clear that securing the commitment of all leadership is needed for a successful cultural transformation. Recognition is highlighted as a crucial tool for leaders because it involves acknowledging and rewarding excellence, which significantly impacts staff engagement.12 Specifically, fostering a diverse and inclusive work environment where recognition and appreciation are integral can enhance the sense of belonging among staff, further supporting retention efforts.12,14 For this reason, the leadership team stressed the importance of revamping the unit's recognition and appreciation practices.12,13,15 After gathering feedback on how staff preferred to be recognized, the R4 Committee developed more tangible and personalized recognition strategies, such as adding a shout-out segment to the daily huddle and introducing a new QR code system for peer recognition. These initiatives helped foster a culture of appreciation and teamwork, which significantly improved the work environment and enhanced collaboration.15 DISCUSSION AND IMPLICATIONS FOR PRACTICE The postpandemic era has highlighted the necessity for nurses to be more actively engaged in professional governance to feel empowered and involved in decision-making processes. Relational and transformational leadership styles are instrumental in achieving this by fostering inclusive and equitable relationships and supporting autonomous nursing practice.1,2,8,9,16 This project demonstrates that adopting these leadership styles allows nursing leaders to more effectively meet staff needs and navigate the complexities of the healthcare environment.8,9,16 Further, the results reinforce the importance of leadership support in facilitating positive change within units. There's a significant need for organizations to reallocate administrative tasks away from frontline leaders, so they can focus on providing support within the unit and engaging in mentoring and relationship-building activities. This shift is crucial for fostering a positive work environment and promoting staff well-being. Additionally, enhancing professional governance is critical for maintaining high standards of care and improving team autonomy, accountability, and engagement.7,17,18 Strong professional governance coupled with robust leadership support forms the cornerstone of high-quality, high-reliability healthcare organizations.7,17,18 Central to this discussion is the pervasive influence of unit culture. A positive and engaging unit culture extends its benefits beyond employee satisfaction—it can profoundly impact patient care. Engaged teams, immersed in a supportive and affirming environment, contribute to improved quality outcomes (such as PACU hold times and FCOTS) and overall enhanced patient experiences. This holistic approach demonstrates that when a unit's culture thrives, every facet of its operation excels, underscoring the adage that culture, indeed, drives everything. THE PIVOTAL ROLE OF NURSE LEADERS Professional governance is fundamental in boosting staff engagement, minimizing turnover, and enhancing staff satisfaction. The efficacy of enhancing professional governance and achieving superior patient outcomes is deeply linked to the robustness, vision, and commitment of nurse leaders. Nursing leadership is pivotal in elevating staff engagement by effectively transmitting an organization's mission, vision, and strategies.19 The maintenance of a positive organizational climate, coupled with the implementation of relational leadership styles and the development of well-trained, high-performing teams, is essential for achieving desired results at both the unit and organization levels.2,3 Leaders are tasked with the responsibility to inspire and mentor their teams, forge meaningful connections, and engage in clear, effective communication to boost team morale and productivity.19 It's critical that leaders not only motivate and empower their teams but also facilitate robust communication channels that enhance overall team dynamics.19 Consequently, organizations must develop systems and structures that nurture and support nurse leaders, enabling them to effectively guide their teams through any challenges they may encounter. Enhancing team cohesion in postpandemic healthcare: Professional governance and relational leadership in a merged perianesthesia care unit TEST INSTRUCTIONS Read the article. The test for this nursing continuing professional development (NCPD) activity is to be taken online at www.NursingCenter.com/CE You'll need to create an account (it's free!) and log in to access My Planner before taking online tests. Your planner will keep track of all your Lippincott Professional Development online NCPD activities for you. There's only one correct answer for each question. A passing score for this test is 8 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost. For questions, contact Lippincott Professional Development: 1-800-787-8985. Registration deadline is June 4, 2027. PROVIDER ACCREDITATION Lippincott Professional Development will award 1.5 contact hours for this nursing continuing professional development activity. Lippincott Professional Development is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, West Virginia, New Mexico, South Carolina, and Florida, CE Broker #50–1223. Your certificate is valid in all states. Payment: The registration fee for this test is $17.95. References 1. Feistritzer NR, Jackson G, Scott C, Willis P. Complex relational leadership: meeting the challenge of postpandemic professional governance. Nurs Adm Q. 2022;46(2):144–153. Cited Here 2. Leclerc L, Strenge-McNabb KK, Thibodeaux T, Campis S, Kennedy K. Relational leadership: a contemporary and evidence-based approach to improve nursing work environments. Nurs Manage. 2022;53(7):24–34. Cited Here 3. Kanninen T, Häggman-Laitila A, Tervo-Heikkinen T, Kvist T. An integrative review on interventions for strengthening professional governance in nursing. J Nurs Manag. 2021;29(6):1398–1409. View full references list |
| Kaddourah B, Al-Tannir M, Kakish S, et al. (June 21, 2020) Perception of Shared Governance Among Registered Nurses in Ambulatory Care Center at a Tertiary Care Hospital in Saudi Arabia. Cureus 12(6): e8736. DOI 10.7759/cureus.8736 | Shared Governance Among Registered Nurses in Ambulatory Care Center at a Tertiary Care Hospital in Saudi Arabia | Shared governance is considered a model for mounting autonomous decision making in nursing profession and practice. This study aimed to assess how registered nurses in an outpatient department in a tertiary care hospital perceive shared governance. We conducted a cross-sectional study among a convenient sample of registered nurses in an outpatient department. A self-administered, Index of Professional Nursing Governance (IPNG) questionnaire was used to measure the study outcome. A descriptive analysis was used to describe nurses' characteristics and study outcomes. A total of 186 nurses completed the questionnaire. Of whom, 151 (92.1%) were female, and 78 (47.3%) were aged between 20 and 30 years. Only 54 (29.3%) and 59 (31.7%) had indicated a shared decision in terms of controls and influence scales, respectively. The majority of the nurses indicated traditional shared across shared governance scales except in the access information scale. The findings showed a prevalent traditional nursing management style in the study setting. Supportive strategies and education must be provided for both managers and staff nurses to develop and implement shared governance in their practice. |
| Kanninen T, Haggman-Laitila A, Tervo-Heikkinen T, Kvist T. J Nurs Manag. 2021; Oct 4. https://doi.org/10.1111/jonm.13489 | Nurses' critical reflections of working in unit practice councils -- A qualitative interview study. | This study aimed to describe nurses' experiences of working as members of unit practice councils. Healthcare organizations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils. A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analyzed using thematic analysis. The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organization's evolving Magnet project. Unit practice councils in the studied organizations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organization. Sharing decision-making power could be a win–win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organizational roles, there is room for trusting each other's professionality and respecting autonomous work. |
| Kanninen T, Haggman-Laitila A, Tervo-Heikkinen T, Kvist T.Leadership in Heal Serv. 2019; Jul 6.https://www.emerald.com/insight/content/doi/10.1108/LHS-10-2018-0051/full/html | Nursing shared governance at hospitals -- Its Finnish future? | The purpose of this study is to describe council structure, its benefits, supportive and obstructive factors and developmental needs as a part of shared governance in a university hospital. This is a descriptive study, where semi-structured interviews with 12 nurses was conducted in 2014 and documents from 75 council meetings from 2009 to 2014 were gathered and analyzed. Qualitative content analysis method was used on the data. The study hospital has been developing nursing shared governance with unique structure and processes of councils. Professors and university researchers act as chair and members are voluntary nursing staff. The factors supporting the councils are nurse managers’ support, enthusiastic personnel and neighboring university. The factors obstructing the councils are lack of time, understanding and skills. The work of the councils benefits the organization by improving patient care, harmonizing nursing practices and informing decision-making. The council’s developmental needs were more visibility, concentration into everyday problems and interprofessionally. Applying nursing shared governance structures into an organization improves the professional practice environment of nursing personnel. The study hospital has its own, unique council structure. It did not cover the whole hospital or all of the nursing personnel, but it is already producing promising results. It should be given an official status and more support from nurse managers, and it should be developed into an inter-professional discussion. The results presented here indicate that shared governance, even, in its early stage, contributes positively to the quality of care, harmonizes nursing practices and informs decision-making. Applying shared governance structures into an organization improves the professional practice environment of nursing personnel. The study showed concrete supporting and obstructing factors that should be notified in nursing leadership. Despite the extensive empirical studies on nursing shared governance, there is very little research on councils in the Scandinavian countries. |
| Kear M, Duncan P, Fansler J, Hunt K J Nurs Admin. 2012;42(6):315-317. | Nursing Shared Governance: Leading a Journey of Excellence | A description of how a community hospital, Lakeland Memorial Hospital, FL, engaged nurses through the nursing shared governance model to select a professional practice model that aligned nursing values and priorities with the organization?s vision and mission. |
| Kennerly S J Nursing Admin. 2000;30(12):611-617 | Perceived worker autonomy: The foundation of shared governance | Indepth analysis of autonomy in relationship to SG and previously published implementation studies and concept analysis. Builds on author's previous longitudinal outcomes study of SG implementation at a Midwestern hospital system and questions previous as |
| Kennerly SM Nurs Economics. 1996;14(2):111-116. | Effects of of shared governance on perceptions of work and work environment | Pre- and postimplementation of modified councilar model (6 and 18 months), based on Path-Goal Theory of Leadership at 450-bed Midwestern hospital; sample size between 113 and 150. Initiating SG did not significantly influence job satisfaction, anticipated turnover, and perceived effectiveness. Increases in autonomy were not sustained over time. |
| Khraisat O, Al-awamreh K, Hamden M, et al. | Shared governance: A children's hospital journey to clinical nursing excellence. | Shared governance is examined through a framework for developing independent decision making in professional nursing practice and improving patient care outcomes. This study is designed to obtain a baseline measurement of the degree of shared governance in a selected children’s hospital in Saudi Arabia. The study was guided by the Donabedian model. The Professional Nursing Governance Index was used. A total of 400 questionnaires were distributed to nurses working at the hospital, with a response rate of 77% (n = 307). Descriptive and inferential statistics were used for analysis. The results corresponded with those from nurses and managers in most subscales of the Index of Professional Nursing Governance (information, goals, resources, participation and practice). However, nurses working in the operating theatre and surgical unit have a perceived higher level of shared governance than those in critical care units and medical wards. The results could encourage shareholders and leaders in the nursing field to develop the perception of shared governance by adopting a shared governance model, which in turn might improve the quality of nursing care. |
| Kovner CT, Hendrickson G, Knickman JR, Finkler SA J Nurs Admin. 1993;23(11):24-34. | Changing the delivery of nursing care. Implementation issues and qualitative findings | Evaluation of programs piloted in 37 hospitals to alleviate the nursing shortage in the 1990s. The NJ state Nursing Incentive Reimbursement Awards funded the programs, which included three shared governance implementation sites. |
| Kramer M, Schmalenberg C, Maguire P, et al West J Nurs Res. 2008; 30(5): 539-559. | Structures and practices enabling staff nurses to control their practice | State-of-the-art mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures. |
| Kutney-Lee A, Germack H, Hatfield L, Kelly S, Maguire P, Dierkes A, Del Guidice M, Aiken L. J Nurs Admin. 2016;46(11):605-612 | Nurse engagement in Shared governance and patient and nurse outcomes | The objective of this study was to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes. There is little empirical evidence examining the relationship between shared governance and patient outcomes. A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores. A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes. |
| Kyytsönen M, Tomietto M, Huhtakangas M, Kanste O. International J of Heal Governance. 2020; 25(4). https://www.emerald.com/insight/content/doi/10.1108/IJHG-04-2020-0032/full/html. DOI: 10.1108/IJHG-04-2020-0032 | Research on hospital-based shared governance: a scoping review | Purpose: The purpose of this study is to review research on hospital-based shared governance (SG), focussing on its core elements. Design/methodology/approach: A scoping review was conducted by searching the Medline (Ovid), CINAHL (EBSCO), Medic, ABI/INFORM Collection (ProQuest) and SveMed+ databases using SG and related concepts in hospital settings as search terms (May 1998–February 2019). Only original research articles examining SG were included. The reference lists of the selected articles were reviewed. Data were extracted from the selected articles by charting and then subjected to a thematic analysis. Findings: The review included 13 original research articles that examined SG in hospital settings. The studied organizations had implemented SG in different ways, and many struggled to obtain satisfactory results. SG was executed within individual professions or multiple professions and was typically implemented at both unit- and organization-levels. The thematic analysis revealed six core elements of SG as follows: professionalism, shared decision-making, evidence-based practice, continuous quality improvement, collaboration and empowerment. Practical implications: An SG framework for hospital settings was developed based on the core elements of SG, the participants and the organizational levels involved. Hospitals considering SG should prepare for a time-consuming process that requires belief in the core elements of SG. The SG framework can be used as a tool to implement and strengthen SG in organizations. Originality/value: The review resumes the tradition of systematically reviewing SG literature, which had not been done in the 21st century. General tendencies of the research scene and research gaps are pointed out. |
| Lamoureaux J, Judkins-Cohn T, Butao R, McCue V, Garcia F. Journal of Research in Nursing, 19(1):69-87, originally published online 4 Oct 2013. | Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG) | Shared governance is considered an innovative management process model that includes shared decision-making between all members of the healthcare workforce and focuses on nurses’ control over their practice and accountability of care. One specific tool that measures shared governance perceptions of nurses is the RN-focused Index of Professional Governance (IPNG). The objective of this study was to assess reliability and add to the validity of the IPNG by further establishing the construct validity and correlating the scale scores to measures of satisfaction obtained from the National Database of Nursing Quality Indicators (or NDNQI) survey. There were 76 respondents representing six units in one hospital. We reported high reliability for each one of the six subscale scores as well as for the total score (Cronbach alphas of 0.94 and higher). Construct validity was supported by the invariance of the scores across age groups along with schooling and experience levels. Concurrent validity was supported by a correlation of the IPNG score with job enjoyment (r = 0.437, p = 0.002) and the desire to recommend the hospital as a place of employment (r = 0.442, p = 0.001). The IPNG should also be tested in other healthcare professionals as its scoring ability can compare management, units and departments. |
| Laschinger HK, Havens DS. J Nurs Admin. 1996;26(9):27-35. | Staff nurse work empowerment and perceived contol over nursing practice. Conditions for work effectiveness. | Study using Rosabeth Kanter's Structural Theory of Organizational Behavior to examine relationships between staff nurses' perceptions of work empowerment and control over practice, and job satisfaction and perceived work effectiveness. Many positive correlations discovered among a sample of 127 nurses. |
| Latta LC, Davis-Kirsch S. J Ped Nurs. 2011; 26(6):580–585. | Developing a Robust Professional Practice Model using a Shared Governance Approach | A description of the development and implementation of a framework for nursing practice in a freestanding children's hospital, Seattle Children's Hospital, and the subsequent improvement process used to transition that framework into a robust professional practice model (PPM). The development of a PPM encompassing all aspects of nursing in all clinical settings is an important milestone on a successful Magnet journey. Strategies for linking the PPM to core processes and structures of nursing are shared. Plans for further study to demonstrate the relationship of a PPM to patient outcomes are discussed. |
| Lee C, Yang K, Wu S, Lee L J Nursing Res (China). 2001;9(2):125-36. | The effectiveness of implementing an unit-based shared governance model [Chinese] | Unit-based SG resulted in an increase in nursing professional governance and work satisfaction for nurses; enhanced partnership between nurses and managers; staff nurses perceived increased autonomy, authority, and expressed opinions to managers more freq |
| Lee L, Yang K, Lee C, and Wu S J Nursing Res (China). 2001;9(1):5-13. | ÿAn evaluative study of the effects of the implementation of UBSG on nurses? perceptions of professional governance [Chinese]. | Nurses in a unit-based SG had a higher level of participation in decision-making and professional practice than those in a traditional unit. Experimental n=29, control=24. |
| Lee M, Pappas S, Yolo R. Nurs Leader. 2025; 23 (5): 1-7. | Engaging. nurses in professional governance across a hospital service line. | Strong professional governance is linked with higher levels of nurse engagement and lower levels of nurse turnover. Nevertheless, a large academic medical center found that professional governance engagement declined after the pandemic. A quality improvement project utilizing the Plan-Do-Study-Act methodology was developed to innovate professional governance, developing and implementing a service line council across eight medical–surgical units of a hospital service line sharing greater clinical, administrative, and educational resources than before. Over 3 months, the project indicated a statistically significant difference in the mean work empowerment scores of clinical nurses participating postsurvey (23.29 out of 30), compared to presurvey (19.75), t = 3.62, df = 31.8, p = .001. The results demonstrate the importance of aligning professional governance with evolving clinical and administrative structures for patients and the profession. |
| Lee M. Voice Nurs Leadership/ 2025;23(6):4-6 | Professional governance as a catalyst for cultural renewal: Leadership in action. | In environments with leadership transitions and strained labor dynamics, sustaining engagement is challenging. Yet nursing practice thrives when voice, belonging and accountability are present. At Providence Regional Medical Center Everett in Everett, Wash., we repositioned professional governance to foreground positive trends and drive near-term progress. In a short period of time, participation and outcomes improved meaningfully underscoring how bold, values-anchored leadership combined with the front-line voice can change culture and improve results. |
| Lindsay M. Nursing Management. 2023;54(3):14-22. DOI: 10.1097/01.NUMA.0000919064.29246.6b | A shared governance approach to nursing documentation redesign using Kotter's change management model. | |
| Malinit C, Gabuya A, Taylor K, Paliwal M, Weaver SH Nursing Management. 2022;53(3):6-10. | Council Fosters Engagement in Research and Shared Governance | Engagement gap |
| Malleo C, Fusilero J Nurse Leader. 2009;7(1):32-26. | Shared governance: Withstanding thet of time | |
| Marturano E, Narva A. Nursing Management. 2023;18(4):6-12 | Nursing ethics and shared governance model | Before the overhaul in 2025, our professional governance structure existed on paper but lacked traction. Attendance at several councils was inconsistent; Unit practice councils (UPCs) struggled to connect their work to organizational priorities; communication loops were sporadic; and the same few staff members carried most of the work. These familiar warning signs in health care mirror concerns surfaced in national surveys of nurse leaders in recent AONL and Journal of Nursing Administration publications. The risk was clear: without an effective channel for nursing voices, we would miss opportunities to improve both the work environment and patient outcomes. |
| McNulty JA Master's thesis. School of Nursing, University of Alaska, Anchorage, November, 2002. | Perceptions of nurses practicing in a shared governance environment | |
| Meyers MM, Costanzo C. Nurs Adm Q. 2015;39(1):51-7. | Shared governance in a clinic system. | This engagement gap no doubt was fed by a tumultuous era at Providence. It was helmed by three CNOs and two CEOs over three years, and experienced a contentious collective bargaining process which culminated in a strike. Those events tested trust and continuity. We needed an approach that would clarify purpose, rebuild predictable pathways for decision-making and deliver early wins apparent to clinical staff. As the incoming CNO, I adopted a bold leadership stance: we would address issues head-on, make values-based decisions and view pivoting as a positive practice — adapting quickly while staying aligned to mission and standards. This mindset gave coherence to our next steps and made it safe for councils to experiment and improve. |
| Minnen TG, Berger E, Ames A, Dubree M, Baker WL, Spinella J J Nurs Admin. 1993;23(7/8):35-40. | Sustaining work redesign innovations through shared governance | |
| Minors SP, White JB, Porter-O'Grady T Topics in Manage. 1996;1:187-196. | ÿAssessing shared governance: An example of instrument development in a hospital setting. | Leadership pivot |
| Mitchell M, Brooks F, Pugh J NT Res. 1999;4(3):192-201 | Balancing nurse empowerment with improved practice and care: an evalution of the impact of shared governance | |
| Moore SC, Hutchison SA J Nurs Admin. 2007;37(12):564-68. | Developing leaders at every level. Accountability and empowerment actualized through shared governance | I began with a two-hour strategy session with the coordinating council co-chair. We mapped every council, charter and reporting pathway, named the gaps and agreed on a shared vision — one which created a simpler, clearer and more inclusive system that could turn insight into action. Then we executed five moves. |
| Moore SC, Wells NJ JONA. 2010;40(11):477-482. | Staff nurses lead the way for improvement to shared governance structure | |
| Moreno V, Girard AS, Foad W JONA. 2018;48(3):160-167. | Realigning shared governance With Magnet® and the organization's operating system to achieve clinical excellence | Structural realignment. We streamlined councils to reduce redundancy, refreshed charters and aligned every council’s work to system priorities (quality, safety, experience, workforce). During the process we looked for gaps and redundancies. We also clarified decision rights and how recommendations escalate and return for feedback. We tied each council’s charter to Providence enterprise priorities (e.g., hospital-acquired pressure injury, central line-associated bloodstream infection, patient experience). Councils would pursue only those projects tied to system priorities. |
| Mouro G, Tashjian H, Bachir R, Al-Ruzzeih M, Hess R. Nursing Economic$. 2013, 31(4):184-89. | Comparing Nurses' Perceptions of Governance Related to Hospitals' Journeys to Excellence Status in the Middle East | |
| Myers M, Parchen D, Geraci M, Brenholtz R, Knisely-Carrigan D, Hastings C. JONA. 2013;43(10):509-516. | Using a shared governance structure to evaluate the implementation of a new model of care: The shared experience of a performance improvement committee | Co-chair development. Incoming co-chairs received onboarding plus brief 60-minute monthly training on inclusive discussion techniques, agenda discipline and follow-through, among other topics. We also offered templates for efficient meetings. Bringing in co-chairs helped spread the culture of improvement. |
| Obisesan O, Hathcock E, Hellebusch E, Robinson A, Stiffler M. Nurs Leader. 2025; 23 (5):1-1-8. | From silos to intentional synergy: Nursing shared governance championing connections and belonging culture | Exceptional patient care hinges on a deeply connected and engaged health care workforce. This mixed-methods study examines the transformative effects of the Healthcaring Together initiative, a pioneering nursing shared governance–led intervention designed to foster connection and belonging among health care staff. Staff interviews unveiled themes of strengthened teamwork, a revitalized workplace culture, and increased recognition/acknowledgment for their contributions. Staff's response to the organization’s employee engagement survey corroborated these findings, showing observable increases in feelings of respect and belonging. Inconsistent implementation, however, emerged as a challenge. The study highlights the importance of intentional strategies to improve workplace culture and environment. |
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| Oss JA, Drenth AR, Olson JM Nurs Leader. 2021;19(1):47-56. | Driving nurse satisfaction trough shared governance | Two-way communication loops. We standardized the summaries going from the Coordinating Council to the UPCs and from the UPCs to the Coordinating Council. We required a five-bullet “What we decided / What’s next” after each council, which was pushed to unit huddles for feedback. We also required “close-the-loop” updates so bedside nurses saw outcomes, not just agendas. We also featured recognition for units during meetings to make wins visible quickly. Visibility fosters engagement. |
| Overcash J, Petty LJ, Brown S Nurs Admin Q. 2012;36(4):E1?E11. | Perceptions of Shared Governance Among Nurses at a Midwestern Hospital | |
| Pinkerton S Nurs Economic. 2008:26(6):401-403. | The unit practice council: Center of professional practice | Transparent metrics and visible sponsorship. We tracked attendance, representation and action item completion. Executives routinely attended council moments of celebration and learning — small signals with big impact. |
| Potratz E, Bushaw A, Weston MJ. Nurs Leader. 2025;23(2):196-204. | Strengthening Clinical Practice Through Professional Governance | |
| Porter-O'Grady T, Clavelle JT. J Nurs Admin. 2021;51(14):206-211. | Transforming shared governance toward professional governance in nursing. | Accountability with support. Clear expectations (participation, preparation, follow through) were communicated and paired with practical support, such as protected time for council work and coaching for participants. Psychological safety was explicitly reinforced so ideas and concerns could surface without penalty — an essential element for professional governance. |
| Prince SB J Nurs Admin. 1996;27(3):28-35. | Shared governance. Sharing power and opportunity | These changes reflect themes in the current literature: when professional governance is structured, supported and inclusive, nurse engagement and quality outcomes improve. |
| Prybil LD J Nurs Care Qual. 1996;27(3):28-35. | Nursing involvement in hospital governance | |
| Quek SJ, Thomson L, Houghton R, Bramley L, Davis S, Cooper J. J Nurs Management. 2021, April. https://doi.org/10.1111/jonm.13321 | Distributed leadership as a predictor of employee engagement, job satisfaction and turnover intention in UK nursing staff | Results |
| Rankin VL, Rose RV Nurs Leader. 2021;18(6):547-51. | President of nursing staff: Reinvigorating shared governance | |
| Redi PP, Cole LC Nrsg Manag. 2024;54(10):42-50. | APRN shared governance in a community hospital: A quality improvement initiative. | These changes greatly increased engagement within six months. From March to August 2025, overall council participation increased 40% and UPC engagement increased 69%. More nurses served as co-chairs, projects diversified across units and meeting quality improved due to clear agendas, time-bound actions and closed loops on projects. |
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| Rheingans J. Nurs Leader. 2012;10(1):40-42. | The Alchemy of Shared Governance: Turning Steel (and Sweat) Into Gold | UPC-led work targeted high-value safety priorities resulting in clinical impacts. |
| Riesch SK, Chiappa J, Floyd N, Ponce M. Nurse Leader. 2023;21(1):31-37. | The chief nursing officer shared leadership model. | |
| Rodriguez-Yu V, Cruz A, Ruiz J, Pickering C. Nurs Manag. 2020;51(9), 29-35 | Empowering nurses to achieve excellence A VA hospital's journey to Pathway to Excellence® designation | Pressure injuries. Council-driven prevention practices (skin assessments, device-related surveillance, positioning and education) reduced rates to the lowest in the division, consistent with contemporary evidence that multifaceted prevention bundles lower prevalence and improve practice. From January to August 2025, pressure injuries dropped 36%. |
| Root SD AORN J.2000;72(1):95-8, 101-2, 104. | Implementing a shared governance model in a perioperative setting | Accreditation readiness. Momentum extended into a Joint Commission survey in June 2025 with zero conditional findings in the Provision of Care domain — a particularly meaningful outcome given national attention to restraint use, pain management and medication titration. The capability to demonstrate policy-to-practice alignment at the point of care was strengthened by the very governance processes nurses owned. |
| Rundquist JM, Givens PL American Nurse Today. 2013; 8(3). | Quantifying the benefits of staff participation in shared governance | Culture and professional pride. During Nurses Week, professional governance partnered with our recognition team to present 28 abstract posters across the hospitals showcasing UPC projects and practical innovations. With limited financial resources, the experience blended learning and belonging. Nurses saw their work elevated and celebrated in public, which reinforced continued participation. |
| Sajan S, Faisal W. Textila Internat J Nurs. 2019;5(22).1-12. | Registered Nurses Perception of Shared Governance with Index Professional | The 2025 AONL Nursing Leadership Insight Study highlights persistent pressures — staffing, violence, emotional well-being — and the need for scalable practices protecting leaders’ strategic time and front-line engagement. Professional governance is one of those scalable practices: it converts distributed expertise into visible outcomes. The rapid gains we observed are consistent with contemporary evidence linking professional governance to better quality, experience, and nurse engagement. In short, professional/shared governance is not an extra: it is the operating system for nursing leadership in complex environments. |
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| Speroni KG, Budhathoki C, Walters C, Dutton S, Mackay P, Oguariri J Nurs Admin. 2022; 52(4):Publish Ahead of Print. Hess R, acknowledged. | Survey research: Do all RN types have the same perceptions regarding professional nursing governance? | |
| Speroni KG, Wisner K, Stafford A, Haines F, AL-Ruzzieh MA, Walters C,Budhathoki C. J Nurs Admin. 2021;51(5): 287-296. https://pubmed.ncbi.nlm.nih.gov/33882557/ Forum for Shared Governance, acknowledged. | Effect of shared governance on nurse sensitive indicator and satisfaction outcomes: An international comparison | Bold and courageous does not mean loud. It means making timely, values-anchored choices visible to staff — and inviting their fingerprints on the solution. |
| Speroni KG, Wisner K, Ober M, Haines F, Walters C, & Budhathoki C. J Nurs Admin. 2021;51 (7/8):379-388.Forum for Shared Governance, acknowledged. | Effect of shared governance on nurse sensitive indicator and satisfaction outcomes by Magnet recognition status | Pivot with purpose. Conditions change. Re-prioritize without apology, explain why and show how the new focus connects to outcomes. |
| Sprouse M. Voice Nurs Leadership. 2025; Nov:4-6. | Professional governance as acatalyst for cultural renewal: Leadership in action. | Governance is a practice, not a project. Keep it lightweight, rhythmic and relentlessly connected to what matters most for patients and staff. |
| Stumpf LR J Nurs Admin. 2001;31:196-202. | A comparison of governance types and patient satisfaction outcomes | Co-chairs are multipliers. Invest here first. The literature and our experience agree: capable council leaders sustain momentum. |
| Styer KA AORN J. 2007;86(July):85-93. | Development of a unit-based practice committee: A form of shared governance | Data closes the loop. Post small dashboards; celebrate traction; pivot when trends stall. |
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| Thyen MN, Theis R, Tebbitt BV. J Nurs Admin. 1993;23:24-26. | Organizational empowerment through self-governed teams. An application in long-term care. | The experience at Providence Everett shows what is possible when bold leadership and professional governance converge. In a short span of time, measurable progress emerged: councils activated, outcomes strengthened and professional pride grew stronger. What began as a strategy for stability has become a platform for acceleration. The gains point to a future where nursing voice continues to shape culture, drive safety and elevate care delivery. Professional governance, seen as aspirational, now stands as a proven pathway and the momentum is still building. |
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| Al-Hamdan ZM, Abu-Erjeh T, Bawadi H, Ahmad M, Alhamdan M, Khalili H. (2022). Jordan Journal of Nursing Research:1(2):47-54. | Shared Governance among Nurses: A Descriptive Study from Jordan. | |
| Zuzelo P, McGoldrick TB, Seminara P, Karbach H Nurs Manag. 2006;37(6):45-50. | Shared governance and EBP: A logical partnership? | While the relationship between shared governance and evidence-based practice is still in its early stages, the Albert Einstein Healthcare Network believes these separate models of care share the same processes and equate to solid, successful nursing. |
Forum for Shared Governance
A clearinghouse for promoting and disseminating research about shared governance
